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Enferm Infecc Microbiol Clin. 2017 May;35(5):287-292. doi: 10.1016/j.eimc.2016.01.012. Epub 2016 Mar 12.

Community-acquired febrile urinary tract infection caused by extended-spectrum beta-lactamase-producing bacteria in hospitalised infants.

[Article in English, Spanish]

Author information

1
Servicio de Pediatría, Hospital Universitario Doctor Peset, Valencia, España; Departamento de Pediatría, Obstetricia y Ginecología, Universitat de València, Valencia, España.
2
Facultad de Medicina y Odontología, Universitat de València, Valencia, España.
3
Servicio de Pediatría, Hospital Universitario Doctor Peset, Valencia, España; Departamento de Pediatría, Obstetricia y Ginecología, Universitat de València, Valencia, España. Electronic address: breton_raf@gva.es.
4
Servicio de Pediatría, Hospital Universitario Doctor Peset, Valencia, España.
5
Servicio de Microbiología Cínica, Hospital Universitario Doctor Peset, Valencia, España; Departamento de Microbiología y Ecología, Universitat de València, Valencia, España.

Abstract

INTRODUCTION:

Extended-spectrum beta-lactamase (ESBL) producing bacteria are infrequent pathogens of urinary tract infections in children. The objective of our study was to investigate the presence, clinically associated characteristics and risk factors for acquisition of urinary tract infection/acute pyelonephritis (UTI/APN) in hospitalised children <2years old caused by community-acquired ESBL.

METHODS:

A case-control study in a second level community hospital in Spain, in which 537 episodes of UTI/APN were investigated in a retrospective study between November 2005 and August 2014. Cases were patients with ESBL strains. For each case, four ESBL-negative controls were selected. A questionnaire with the variables of interest was completed for every patient, and the groups were compared.

RESULTS:

ESBL-positive strains were found in 19 (3,5%) cultures. Of these 16 (84%) were Escherichia coli. Vesicoureteral reflux (VUR) of any grade was more frequent in the ESBL group (60 vs. 29%), although without statistical significance. Relapses were more frequent in the ESBL group (42% vs. 18%) (P=.029; OR=3.2; 95%CI: 1.09-9.5). The prevalence of UTI/APN due to ESBL-positive strains increased slightly from 2.7% in the period 2005-2009 to 4.4% in the period 2010-2014.

CONCLUSIONS:

ESBL UTI/APN were associated with more frequent relapses. VUR of any grade was twice more frequent in the ESBL group. Piperacillin/tazobactam, fosfomycin and meropenem showed an excellent activity. Aminoglycosides may be a therapeutic option, and in our patients gentamicin was the antibiotic most used.

KEYWORDS:

Betalactamasas de espectro extendido; Community-acquired infection; Extended-spectrum beta-lactamases-producing bacteria; Factores de riesgo; Infants; Infección adquirida en la comunidad; Infección urinaria; Niños; Risk factors; Urinary tract infection

PMID:
26976379
DOI:
10.1016/j.eimc.2016.01.012
[Indexed for MEDLINE]

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